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Remifentanil - pain relief for birth

Hi guys,

Had a search and coundn't find a thread about this topic already. (unless baby brain has REALLY kicked in and i've missed it!)

DH and I are just back from an antenatal class about birth and pain relief. We discovered that our local hosp doesn't use pethadine, they use morphine instead. We aren't really keen on using that as it stays in babies blood stream for a while.

However, the MW did talk briefly of a 'new drug' (might only be new in our area) called Remifentanil. From what I can remember it is a self-administered drug (after initial set up) but it works really quickly and wears off really quickly - so doesn't linger in your system and doesn't go through to baby.

Hoping for some stories of positive and negative experiences please . . .

I had this for my labour and for me personally I didn't think it was that great - but my pain threshold is rubbish so others may have thought it wonderful. I was pretty out of it for my labour (pethadine, gas and air) but I remember the contractions very clearly and don't feel like they were less painful for taking this drug. I remember I had a thing to press and then it wouldn't let you press it again for about 5 minutes I think, so you didn't take too much.

My labour wasn't great though (28 hours!) and the epidural didn't work either - it kept falling out!! In the end I had a spinal block in theatre and it was the best feeling ever - no more pain LOL!

Sorry my story isn't positive in terms of pain relief but I did have a healthy baby boy

Sorry I can't offer any information about this drug as I haven't heard about it but just in case you do review your options again, I used diamorphine during my labour (aswell as gas & air initially and eventually an epidural). I can totally understand that you wouldn't want to use Morphine but when labour comes decisions can change and if that is the case for you I thought I would just let you know that having used Diamorphine, my little boy arrived safe and well with no ill effects.

Labour is such a personal experience I think you are right to explore all options and please don't think I am preaching because what is right for one isn't for another but thought I would mention this in case it helps with your ultimate decisions.

I was adamant I didn't want an epidural and was certain I could manage without it but in the end I didn't have the pain tolerance I thought I would and asked for an epidural and have no regrets as I know it was right for me at the time xx

Strange - that is one application that I have never heard of for Remifentanil. I have known of this drug for years but we only ever use/used it in combination with a general anaesthetic or for post-operative pain relief and sedation for ventilated patients. It does wear of pretty quickly but I personally would refuse it if I were offered it as I do not know of it being used for labour (as I have already said - forgive me, I'm tired)

They can often give pethidine or tramadol in IV solution via a PCA (patient controlled analgesia) and even morphine can be given this way - the dosage is much less than when they give you an injection. This means that you press the button to give yourself an extra dose. Once again, I have never seen Remifentanil given via a PCA.

Hi,
Just asked my own personal anaesthetist that shares my bed. Clearly this is too late for you FoxyPink so apologies.
Remifentanil is used frequently as a PCA (patient controlled analgesia) and is now used increasingly in obstetrics. A PCA is just a drip in your hand attached to the medicine and you push a button when it hursts alot!
It is an alternative to an epidural (pain relief administered by a catheter into the back). I guess pros are - it isn't a tube in your back if you don't like the idea of it, it doesn't carry the risks of an epidural, can be used if you can't have an epidural. Not sure how the efficacy compares - I suspect not quite as efficacious but some other benefits instead.

Hey Fuzz-Bo,
I've lost my access to the diaries so haven't been able to check-in. Hope all well with you.

I guess - hopefully neither in an ideal world. Not all units will offer remi. I think if I wanted it would have epidural because that has applications if you needed to go on to have an instrumental delivery or Csection. Would of course be guided mainly by the health care professional looking after me.